Farmacia Hospitalaria (English Edition)最新文献

Objective

To analyse the proportion of patients whose blood pressure values have remained within the established therapeutic aim, so as to reduce cardiovascular risk following therapeutic exchange of angiotensin II receptor antagonists (AIIRA).

Methods

Analytical, observational, prospective, longitudinal study with pre-post analysis. Patients undergoing AIIRA treatment who were not included in the hospital's pharmacotherapeutic guide were included in the study over those who had undergone a normalised therapeutic exchange of AIIRA. Variable response: proportion of patients whose blood pressure levels (BP levels) remained within the established therapeutic aim for the prevention of cardiovascular accidents. Other variables: systolic and diastolic blood pressure values (SBP and DBP) in the month prior to hospitalisation and after therapeutic exchange, antihypertensive medication, comorbidities.

Results

Thirty-seven patients were included in the study. Following therapeutic exchange, 81.08% maintained BP values within the range established by the European Society of Hypertension-European Society of Cardiology Committee. SBP difference: 4.82 (95% confidence interval [CI], −1.09 to 10.74; P=.107); DBP difference: −0.15 (95% CI, −3.27 to 2.97; P=.924), and therefore not clinically significant.

Conclusions

The normalised procedure for therapeutic exchange of AIIRA is effective and safe for patients in terms of maintaining BP, which allows for adequate control of BP during the hospital stay.

Objectives

To evaluate the quality of the pharmacotherapeutic recommendations included in the Integrated Care Processes (PAIs regarding its initials in Spanish) of the Andalusian Ministry of Health, published up to March 2008, through the design and validation of a tool.

Methods

The assessment tool was designed based on similar instruments, specifically the AGREE. Other criteria included were taken from various literature sources or were devised by ourselves. The tool was validated prior to being used. After applying it to all the PAIs, we examined the degree of compliance with these pharmacotherapeutical criteria, both as a whole and by PAIs subgroups.

Results

The developed tool is a questionnaire of 20 items, divided into 4 sections. The first section consists of the essential criteria, and the rest make reference to more specific, non essential criteria: definition of the level of evidence, thoroughness of information and definition of indicators. It was found that 4 of the 60 PAIs do not contain any type of therapeutic recommendation. No PAI fulfils all the items listed in the tool, however, 70 % of them fulfil the essential quality criteria established.

Conclusions

There is a great variability in the content of pharmacotherapeutical recommendations for each PAI. Once the validity of the tool has been proved, it could be used to assess the quality of the therapeutic recommendations in clinical practice guidelines.

Introduction

The objective of this study is to analyse the appropriateness and characteristics of drug dose calculation for hospitalised, morbidly obese patients.

Methods

Retrospective, descriptive study of dose calculations for drugs prescribed to hospitalised, morbidly obese patients in a tertiary hospital in 2007. The recommendations prepared by the Pharmacy division are used as a standard.

Results

We included 62 patients. The mean number of medications prescribed per patient was 12.1 (4–39), and an average of 2.4 (1–10) are listed in the recommendations. A total of 135 drugs were prescribed. Dose calculations for 81 of the above (60%) coincided with recommendations and 54 (40%) did not; there were 51 cases of underdosing and three cases of overdosing.

Discussion

Improper dosing was detected for prescriptions in the systemic antibiotic and antithrombin drug groups, with underdosing being more common than overdosing.

Dabigatran is the first available oral direct thrombin inhibitor anticoagulant. Absorption of the prodrug, dabigatran etexilate and its conversion to dabigatran is rapid (peak plasma concentrations are reached 4–6 h following surgery, and a further 2 h later). Its oral bioavailability is low, but shows reduced interindividual variability. Dabigatran specifically and reversibly inhibits thrombin, the key enzyme in the coagulation cascade. Studies both in healthy volunteers and in patients undergoing major orthopaedic surgery show a predictable pk/pd profile that allows for fixed-dose regimens. The anticoagulant effect correlates adequately with the plasma concentrations of the drug, demonstrating effective anticoagulation combined with a low risk of bleeding. Dabigatran is mainly eliminated by renal excretion (a fact which affects the dosage in elderly and in moderate-severe renal failure patients), and no hepatic metabolism by cytochrome P450 isoenzymes has been observed, showing a good interaction profile.

Rivaroxaban will probably be the first available oral factor Xa (FXa) direct inhibitor anticoagulant drug. It produces a reversible and predictable inhibition of FXa activity with potential to inhibit clot-bound FXa. Its pharmacokinetic characteristics include rapid absorption, high oral availability, high plasma protein binding and a half-life of aprox. 8 h. Rivaroxaban elimination is mainly renal, but also through faecal matter and by hepatic metabolism. Although the drug has demonstrated moderate potential to interact with strong CYP3A4 inhibitors, it does not inhibit or induce any major CYP450 enzyme.

Introduction

A bezoar is a hard mass of undigested foreign matter found in the gastrointestinal system. The most common type is the phytobezoar, which is composed of vegetable fibres. There is no current consensus as to its treatment. Three cases of phytobezoars treated with cellulase are described.

Patients and method

Case 1: patient with large gastric phytobezoar. Initial treatment with nasogastric cola drink lavages was ineffective. Subsequent treatment with cellulase was successful. Case 2: patient with gastric phytobezoar who was treated with cellulase and metoclopramide. Definitive fragmentation was performed with the endoscopy technique. Case 3: patient with large intestinal phytobezoar. The patient was treated by endoscopic lysis with partial success. Subsequent treatment with cellulase led to complete disintegration. In all the cases, cellulase was administered in pure form by nasogastric tube, and none of the patients suffered adverse effects.

Conclusions

Treatment with cellulase is based on the enzymatic degradation of the bezoar. It has been shown to be effective as the treatment of choice in earlier studies with few patients. This agent seems to be a good alternative for patients with large phytobezoars.

Refeeding syndrome is a complex syndrome that occurs as a result of reintroducing nutrition (oral, enteral, or parenteral) to patients who are starved or malnourished. Patients can develop fluid-balance abnormalities, electrolyte disorders (hypophosphataemia, hypokalaemia, and hypomagnesaemia), abnormal glucose metabolism, and certain vitamin deficiencies. Refeeding syndrome encompasses abnormalities affecting multiple organ systems, including neurological, pulmonary, cardiac, neuromuscular, and haematological functions. Pathogenic mechanisms involved in the refeeding syndrome and clinical manifestations have been reviewed. We provide suggestions for the prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk, reintroduce nutrition cautiously and correct electrolyte and vitamin deficiencies properly.

Introduction

The direct transfer of the results of pharmaco-economic studies between countries may not be suitable if the proper adaptations are not made to take into account differences in treatment patterns, resource use, and costs from country to country.

Objective

To estimate the cost in Spain of treating anaemia secondary to chronic renal failure with darbepoetin alpha or epoetin alpha from a review and analysis of available current information. In addition, the role of the route of administration as a main driver of the cost will be analysed.

Method

Population: patients with chronic renal failure induced anaemia. Data: Medline and Embase search of studies directly comparing erythropoiesis stimulating agents. Analysis: Cost minimization analysis from the perspective of a hospital pharmacy department. The main outcome chosen was the difference between the average cost per patient undergoing a 30-day treatment with epoetin alpha versus darbepoetin alpha.

Results

a) Haemodialysis: changing from epoetin alpha to darbepoetin alpha is associated with a cost reduction of 8.67%; 95% CI, −1.34 to 17.92 (€uro17.48; 95% CI, −2.70 to 36.13); probabilistic analysis showed that the use of darbepoetin alpha could be associated with a costsaving probability of 94.9%. The IV administration yielded a decrease in costs of about 16.00%; 95% CI, −2.38 to 36.77 (€uro41.78, 95% CI: −6.21 to 96.04); b) Pre-dialysis: darbepoetin alpha is associated with a cost reduction of about 11%–32%.

Conclusions

The use of darbepoetin alpha for the treatment of chronic renal failure induced anaemia (haemodialysis and pre-dialysis) shows higher cost efficiency than epoetin alpha in Spain; these differences increase with IV administration.

Objective

To assess the effectiveness and safety of the use of erlotinib in the treatment of refractory cervical cancer after retrospective analysis of 2 clinical cases.

Methods

The clinical records were assessed for the patients who started treatment with erlotinib, on a compassionate-use basis, with an oral dosage of 150 mg/day until June 2008. The pharmacy dispensing records were also assessed to evaluate adherence to treatment. Progression-free survival was assessed and adverse reactions were recorded in the medical records.

Results

Three patients with recurrent, advanced cervical cancer were candidates for treatment with erlotinib, 2 of whom were only starting treatment. In both cases, the women had previously received between 3 and 4 different treatment lines. Progression-free survival was 6 months and 4 months in each case. The adverse reactions to the treatment were slight.

Conclusions

Erlotinib presented some similar results to those obtained from cisplatin doublets in women with refractory cervical cancer, with minor adverse effects. However, these results need to be corroborated in the clinical studies field on a wider section of the population.

Objectives

In this study we will analyse the use of cetuximab in the treatment of metastatic colorectal cancer (MCC) in a third level hospital. We will establish the usage conditions in our centre in keeping with those approved in current technical records. We will also record the treatment duration under the different usage conditions and use the information available in material that has been published to date.

Methods

An indication-prescription study of cetuximab in MCC was carried out on all patients treated with cetuximab for colorectal cancer in the period between 2004 and 2007 in our hospital. The number of prescriptions that do not fit the approved recommendations for cetuximab in MCC treatment (and why they do not fit) is determined. Descriptive statistical analysis was carried out for the different variables collected, and a Kaplan-Meier analysis was carried out for the treatment duration variable, so as to determine whether there is a difference in effectiveness for the common uses in our hospital.

Results

Data was recorded for 74 patients treated with cetuximab. The average cost per patient was €14 399 and on average, 15.3 dosages were administered per patient. The average initial dosage was 710 mg with an average dosage of 446 mg after that. The average duration of the treatments was 15.4 weeks. cetuximab was administered to 7 patients as first-line treatment and to 32 patients who had not used irinotecan previously. Irinotecan was not associated with cetuximab treatment in 9 patients, and it was used in 14 patients resulting in a negative outcome for the EFGR test. Treatment duration was longer in the case of its use as first-line treatment (27.7 weeks), if irinotecan had not been used before (23.3 weeks), if irinotecan was used (20.5 weeks) and in patients with positive EFGR results (19.6 weeks.) The median treatment duration, under the different conditions, was less than the average but with no major differences between them. 70.3% of prescriptions did not fit with the data sheet.

Conclusions

The use of cetuximab under different conditions to those approved on the technical data sheet creates an increase in the number of patients treated and a longer duration of the treatments which implies an increase in intake. The average and the mean treatment times for the usage conditions found did not present any significant statistical differences. There are a small number of patients who benefit from this treatment which can be seen by the large average, in comparison with the mean, without any of the conditions in which the analysis was carried out seeming to determine a higher response. The treatment duration in our study was similar to the durations recorded in relevant literature for these usage conditions.

Objective

To analyse the characteristics and cost of medical prescriptions given upon discharge from the casualty department, as well as the savings made by making substitutions with generis drugs or other equivalent pharmaceutical products in a third level hospital.

Methods

Six hundred sixty-nine patients were chosen using a cluster sample with a sub-sample. The following variables were considered: a) analysis of the prescription (medication quantification, active ingredients and most prescribed therapeutic groups, and possibility of prescribing generis drugs); b) calculation of cost and saving estimate (price to public and equivalent products); and c) prescription quality (adherence to the guide and percentage of products of high therapeutic use.)

Results

Three hundred seventy of the 669 patients received medication when they were discharged, with an average of 1.7 per patient. Six hundred twenty-nine products were prescribed, 16% due to their active ingredient, with 37.53% generic products available. The main active ingredients prescribed were paracetamol, ibuprofen, and omeprazole amounting to 26.70% of the total prescribed and the therapeutic groups that were highlighted were locomotor apparatus, the nervous system, the digestive apparatus, and metabolism with 69.39% of the total. Ninety-two point eighty-four pecent of the prescriptions adhered to the pharmacotherapeutic guide and 98.41% were of high therapeutic use. The annual cost of prescribed medication was €1 013 778 and the saving made by generic product substitution and a programme of therapeutic equivalents was €145 971.

Conclusions

A prescription based on its active ingredients and a therapeutic and generis substitution produce a significant saving both for the patient and for the hospital.